<div id="content">
<center>
<h1>Inscription membre et bien être</h1>
<font style="font-size:30px">&bull;</font><br />
<font style="color:#ba924d; font-size:20px">Vous etes un nouveau membre ?<br />Inscrivez-vous ici</font>
<br />

    
    
    <div id="form-signup">
        <?php 
        $attributes = array('id' => 'form');
        echo form_open('pages/compte', $attributes); ?>
            <div class="field">
            	<label>Email <span style="color:#F00">*</span></label>
                <input id="input" type="text" name="email" value="<?php echo set_value('email'); ?>" size="30" />
				<?php echo form_error('email'); ?>
            </div>
            <div class="field">
            	<label>Mot de passe <span style="color:#F00">*</span></label>
                <input id="input" type="password" name="password" value="<?php echo set_value('password'); ?>" size="30" />
				<?php echo form_error('password'); ?>
            </div>
            <div class="field">
                <label>Confirmation <span style="color:#F00">*</span></label>
                <input id="input" type="password" name="passconf" value="<?php echo set_value('passconf'); ?>" size="30" />
                <?php echo form_error('passconf'); ?>
            </div>
            <div class="field">
                <label>Civilite <span style="color:#F00">*</span></label>
                <div class="gender-fields">
                    <span>Madame</span><input style="border:0px solid black" class="input" type="radio" name="civilite" value="Mme"  />
                    <span>Monsieur</span><input style="border:0px solid black"  class="input" type="radio" name="civilite" value="Mr"  />
                    <span>Mademoiselle</span><input style="border:0px solid black"  class="input" type="radio" name="civilite" value="Mlle"  />
                    <?php echo form_error('civilite'); ?>
            	</div>
            </div>
            <div class="field">
                <label>Prenom <span style="color:#F00">*</span></label>
                <input id="input" type="text" name="prenom" value="<?php echo set_value('prenom'); ?>" size="30"  />
                <?php echo form_error('prenom'); ?>
            </div>
            <div class="field">
                <label>Nom <span style="color:#F00">*</span></label>
                <input id="input" type="text" name="nom" value="<?php echo set_value('nom'); ?>"  size="60" />
                <?php echo form_error('nom'); ?>
            </div>
            <div class="field">
                <label>Adresse <span style="color:#F00">*</span></label>
                <input id="input" type="text" name="adresse" value="<?php echo set_value('adresse'); ?>" size="30"  />
                <?php echo form_error('adresse'); ?>
            </div>
            <div class="field">
                <label>Adresse (suite)</label>
                <input id="input" type="text" name="adresse_suite" value="<?php echo set_value('adresse_suite'); ?>"  size="30" />
                <?php echo form_error('adresse_suite'); ?>
            </div>
            <div class="field">
                <label>Code postal <span style="color:#F00">*</span></label>
                <input id="input" type="text" name="codepostal" value="<?php echo set_value('codepostal'); ?>"  size="30" />
                <?php echo form_error('codepostal'); ?>
            </div>
            <div class="field">
                <label>Ville <span style="color:#F00">*</span></label>
                <input id="input" type="text" name="ville" value="<?php echo set_value('ville'); ?>"  size="30" />
                <?php echo form_error('ville'); ?>
            </div>
            <div class="field" >
                <label>Pays <span style="color:#F00">*</span></label>
				<div style="padding-top:10px"><?php echo country_dropdown('pays', array('FR')); ?></div>
                <?php echo form_error('pays'); ?>
            </div>
        <br/>
            <div class="field">
                <label>Fixe <span style="color:#F00">*</span></label>
                <input id="input" type="text" name="fixe" value="<?php echo set_value('fixe'); ?>" size="30"  />
                <?php echo form_error('fixe'); ?>
            </div>
            <div class="field">
                <label>Portable <span style="color:#F00">*</span></label>
                <input id="input" type="text" name="portable" value="<?php echo set_value('portable'); ?>"  size="30" />
                <?php echo form_error('portable'); ?>
            </div>
            <div class="field">
                <label>Date de naissance</label>
                <input id="input" type="text" name="datenaissance" value="<?php echo set_value('datenaissance'); ?>"  size="30" />
                <?php echo form_error('datenaissance'); ?>
            </div>
            <div class="field">
                <label style="width:350px" for="promotion">Recevoir nos promotions de dernieres minutes</label>
                <input class="checkbox" type="checkbox" name="promotion" id="promotion"/>
            </div>
            
            <div class="field">
            	<input class="submit" type="submit" value="Submit" />
            </div>
           

    </div>
    
    </center>
    
</div>
<br style="clear: both">